Universal newborn hearing screening and postnatal hearing loss.

OBJECTIVE: The goal of this study was to determine the percentage of children who have a postnatal permanent childhood hearing impairment (PCHI) and the percentage thereof who have risk indicators for a postnatal hearing loss. METHODS: Data were drawn retrospectively from the clinical charts of children who had bilateral PCHI (>40 dB hearing level, better ear, unaided) and had undergone universal newborn hearing screening (UNHS) between 1995 and 2000 in various Austrian hospitals. A hearing loss was recognized as postnatal when a child passed UNHS but was later found to have a hearing impairment. The presence of risk indicators, as suggested by the Year 2000 Statement of the American Joint Committee on Infant Hearing (JCIH), was assessed by reviewing the children's clinical charts. RESULTS: Of a total of 105 children with bilateral PCHI, 23 (22%) showed postnatal impairment. After correction of this number for underascertainment, postnatal impairment was estimated to account for 25% of all bilateral PCHI at age 9 years. Risk indicators were found in 17 children but did not fully correspond to those proposed by the JCIH. The risk factors found were a family history of hearing loss (3 children), meningitis (2), craniofacial malformation (2), persistent pulmonary hypertension (1), congenital cytomegaly infection (1), extracorporeal membrane oxygenation (1), recurrent otitis media with effusion (1), and, in addition to the JCIH list, ototoxic therapy (5), and birth before 33rd gestational week (2) (1 child had a combination of the last 2). Six children showed no risk indicators for the postnatal hearing loss. CONCLUSIONS: Our findings suggest that approximately 25% of bilateral childhood hearing loss is postnatal, which supports the leading role of UNHS in detecting PCHI. Provisions for also identifying postnatal cases nevertheless are justified. Because in some of these children no risk indicators are detectable and in others the hearing deterioration starts after age 3 years, audiologic monitoring of at-risk children up to this age may not be sufficient. Additional methods, such as hearing screening at nursery schools or schools, are recommended.

Ten-year outcome of newborn hearing screening in Austria.

OBJECTIVE: Current health care standards recommend that congenital hearing loss be confirmed before age three months and intervened for before age six months. This study evaluated to what extent the Austrian universal neonatal hearing screening (UNHS) program achieves this goal. The Austrian UNHS program is a hospital-based, two-stage screen based on transient oto-acoustic emissions, as promoted in 1995 in a position paper of the Austrian ENT Society. METHODS: Retrospective chart review and data analysis. All Austrian institutions engaged in the diagnosis and treatment of childhood hearing loss were requested to provide their data on children with permanent congenital sensorineural hearing impairment registered since 1990. Children who had undergone hearing screening, were compared to those who had not. Main outcome measures were age at confirmation of and age at intervention for the hearing loss. In each group, the percentage of children, whose hearing loss was confirmed by age three months, and intervened for by age six months, was determined. RESULTS: Data from 321 hearing-impaired children were useable. Of these children, 167 were screened and 154 were not. At age three months, a hearing loss was diagnosed in 35% of screened children, but in only 2% of unscreened. These percentages rose to 69% and 6%, respectively, at age six months and to 81% and 12%, respectively, at age one year. Intervention mostly started within less than one month after diagnosis. At age six months, 61% of screened children, but only 4% of unscreened children, had undergone intervention. CONCLUSIONS: Hearing screening enormously increases the number of early-detected children. However, in quite a few screened children hearing loss is neither confirmed within three months after birth, nor intervened for within six months after birth. Reasons for the delay must be paid attention in order to warrant that UNHS can be as effective as possible.